Articulation joint for apparatus for endoscopic procedures

ABSTRACT

An endoscopic surgical device is provided and includes an endoscopic anchor retaining/advancing assembly including a proximal tube portion and a distal tube portion pivotably connected to one another at an articulation joint; a proximal inner shaft rotatably disposed within the proximal tube portion; a distal inner shaft rotatably disposed within the distal tube portion; and a relatively flexible intermediate drive cable mechanically interconnecting the proximal inner shaft and the distal inner shaft, wherein the intermediate drive cable extends across the articulation joint, wherein the intermediate drive cable defines a central longitudinal axis that is off-set a radial distance from a central longitudinal axis of the proximal tube portion and the distal tube portion.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical apparatus, devices and/orsystems for performing endoscopic surgical procedures and methods of usethereof. More specifically, the present disclosure relates to anarticulation joint for surgical apparatus, devices and/or systems forperforming endoscopic surgical procedures.

2. Background of Related Art

During laparoscopic or endoscopic surgical procedures, access to asurgical site is achieved through a small incision or through a narrowcannula inserted through a small entrance wound in a patient. Because oflimited area to access the surgical site, many endoscopic surgicaldevices include mechanisms for articulating the tool assembly of thedevice. Typically, the articulating mechanism is controlled by anactuator which has to be manipulated by a surgeon to properly orient thetool assembly in relation to tissue to be treated.

Some endoscopic surgical devices utilize torque-transmitting flexibledrive cables and the like to transmit rotation around an articulationjoint of the endoscopic surgical device. In order to accommodate thearticulation desired, relatively more flexible torque-transmittingcables are used. However, the more flexible a cable is, the more“wind-up” of the cable that takes place and the more loss of the torquetransmission that occurs.

Accordingly, a need exists for endoscopic surgical devices which utilizetorque-transmitting flexible drive cables capable of transmittingrelatively more torque, with a decrease in the degree of loss of torquetransmission while maintaining a degree of articulation of theendoscopic surgical device.

SUMMARY

The present disclosure relates to electromechanical, hand-held surgicalapparatus, devices and/or systems configured for use with removabledisposable loading units and/or single use loading units for clamping,cutting and/or stapling tissue.

According to an aspect of the present disclosure, an endoscopic surgicaldevice is provided and includes a handle assembly including a handlehousing and a trigger operatively connected to the handle housing, and adrive mechanism actuatable by the trigger; and an endoscopic anchorretaining/advancing assembly extending from the handle assembly. Theendoscopic anchor retaining/advancing assembly including a proximal tubeportion and a distal tube portion pivotably connected to one another atan articulation joint, each of the proximal tube portion and the distaltube portion defining a central longitudinal axis; a proximal innershaft rotatably disposed within the proximal tube portion, wherein theproximal inner shaft is relatively rigid, and wherein the proximal innershaft is mechanically connected to the drive mechanism such thatactuation of the trigger results in rotation of the proximal innershaft; a distal inner shaft rotatably disposed within the distal tubeportion, wherein the distal inner shaft is relatively rigid; and anintermediate drive cable mechanically interconnecting the proximal innershaft and the distal inner shaft, wherein the intermediate drive cableis relatively flexible as compared to the proximal inner shaft and thedistal inner shaft, wherein the intermediate drive cable extends fromand between the proximal tube portion and the distal tube portion,across the articulation joint, wherein the intermediate drive cabledefines a central longitudinal axis and wherein the central longitudinalaxis of the intermediate drive cable is off-set a radial distance fromthe central longitudinal axis of the proximal tube portion and thedistal tube portion.

The endoscopic surgical device also including at least one fastenerloaded in the distal tube portion, wherein the at least one fastener isacted upon by the distal inner shaft upon an actuation of the trigger.

According to another aspect of the present disclosure, an endoscopicsurgical device is provided which comprises an endoscopic anchorretaining/advancing assembly including a proximal tube portion and adistal tube portion pivotably connected to one another at anarticulation joint, each of the proximal tube portion and the distaltube portion defining a central longitudinal axis; a proximal innershaft rotatably disposed within the proximal tube portion, wherein theproximal inner shaft is relatively rigid, and wherein the proximal innershaft is mechanically connected to a drive mechanism such that actuationof the drive mechanism results in rotation of the proximal inner shaft;a distal inner shaft rotatably disposed within the distal tube portion,wherein the distal inner shaft is relatively rigid; and an intermediatedrive cable mechanically interconnecting the proximal inner shaft andthe distal inner shaft, wherein the intermediate drive cable isrelatively flexible as compared to the proximal inner shaft and thedistal inner shaft, wherein the intermediate drive cable extends fromand between the proximal tube portion and the distal tube portion,across the articulation joint, wherein the intermediate drive cabledefines a central longitudinal axis and wherein the central longitudinalaxis of the intermediate drive cable is off-set a radial distance fromthe central longitudinal axis of the proximal tube portion and thedistal tube portion.

The endoscopic surgical device also comprises at least one fastenerloaded in the distal tube portion, wherein the at least one fastener isacted upon by the distal inner shaft upon an actuation of the drivemechanism.

The distal tube portion may be is articulatable between anon-articulated orientation and a plurality of articulated orientationsrelative to the proximal tube portion.

The central longitudinal axis of the proximal tube portion and thecentral longitudinal axis of the distal tube portion may define acentral radius of curvature for each articulated orientation of thedistal tube portion relative to the proximal tube portion. The centrallongitudinal axis of the intermediate drive cable may define a radius ofcurvature that is greater than the central radius of curvature for eacharticulated orientation of the distal tube portion relative to theproximal tube portion.

The central longitudinal axis of the intermediate drive cable may beoff-set from the central longitudinal axis of the proximal tube portionand the central longitudinal axis of the distal tube portion in adirection away from a direction of articulation of the distal tubeportion relative to the proximal tube portion.

The intermediate drive cable may have an outer diameter of about 0.08″and wherein the proximal tube portion and the distal tube portion mayeach have an outer diameter of about 0.22″.

A ratio of an outer diameter of the intermediate flexible drive cable toan outer diameter of either the proximal tube portion or the distal tubeportion may be 2.8.

Further details and aspects of exemplary embodiments of the presentinvention are described in more detail below with reference to theappended figures.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present disclosure are described herein withreference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of an endoscopic surgical device accordingto an aspect of the present disclosure;

FIG. 2 is a perspective view, with parts separated, of the endoscopicsurgical device of FIG. 1;

FIG. 3 is an enlarged, perspective view, with parts separated, of anendoscopic anchor retaining/advancing assembly of the endoscopicsurgical device of FIGS. 1 and 2;

FIG. 4 is an enlarged view of the indicated area of detail of FIG. 3;

FIG. 5 is a cross-sectional view of an articulation joint of theendoscopic anchor retaining/advancing assembly, as taken through 5-5 ofFIG. 1, shown in an non-articulated condition;

FIG. 6 is a cross-sectional view of an articulation joint of theendoscopic anchor retaining/advancing assembly, as taken through 5-5 ofFIG. 1, shown in an articulated condition;

FIG. 7 is an enlarged, cross-sectional view of a distal end of theendoscopic anchor retaining/advancing assembly, as taken along 7-7 ofFIG. 1;

FIG. 8 is a perspective view of an alternate embodiment of a distal endof the endoscopic anchor retaining/advancing assembly for use in anendoscopic surgical device;

FIG. 9 is an elevational view of a distal end of a shaft assembly and anend effector secured thereto, for another endoscopic surgical device;and

FIG. 10 is a longitudinal, cross-sectional view of the distal end of theshaft assembly and the end effector for the endoscopic surgical deviceof FIG. 9.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the presently disclosed endoscopic surgical device isdescribed in detail with reference to the drawings, in which likereference numerals designate identical or corresponding elements in eachof the several views. As used herein the term “distal” refers to thatportion of the endoscopic surgical device, that is farther from theuser, while the term “proximal” refers to that portion of the endoscopicsurgical device that is closer to the user.

Non-limiting examples of endoscopic surgical devices which may includearticulation joints according to the present disclosure include manual,mechanical and/or electromechanical surgical tack appliers, surgicalclip appliers, surgical staplers, surgical stitching devices and thelike.

Referring initially to FIGS. 1-7, an exemplary endoscopic surgicaldevice, in the form of an endoscopic surgical tack applier is showngenerally as 100. Tack applier 100 includes a handle assembly 110, andan endoscopic anchor retaining/advancing assembly 130 extending fromhandle assembly 110 and configured to store and selectively release orfire a plurality of anchors 10 therefrom.

In accordance with the present disclosure, it is contemplated thatendoscopic anchor retaining/advancing assembly 130 may include a pivotor articulation joint 150 provided along a length thereof. As seen inFIGS. 1-6, endoscopic anchor retaining/advancing assembly 130 includes aproximal tube portion 130 a, a distal tube portion 130 b pivotallyconnected to proximal tube portion 130 a by a pivot pin 130 c atarticulation joint 150.

As seen in FIGS. 1 and 2, handle assembly 110 includes a handle housing112 pivotably supporting a trigger 114. Trigger 114 is operativelyconnected to a drive mechanism 116 such that each squeeze of trigger 114results in a rotation of an inner shaft assembly 138 of proximal tubeportion 130 a of anchor retaining/advancing assembly 130.

Reference may be made to U.S. Patent Publication No. 2011/0087240, filedon Oct. 20, 2010, the entire content of which is incorporated herein byreference, for a discussion and description of the operation andconstruction of aspects of handle assembly 110 and/or anchorretaining/advancing assembly 130 of tack applier 100, and for adiscussion and description of the construction of anchors 10.

As seen in FIGS. 1-6, proximal tube portion 130 a of anchorretaining/advancing assembly 130 includes an outer proximal tube 132secured to and extending from handle housing 112, a stiffener tube 134concentrically and slidably disposed within outer proximal tube 132, anda relatively rigid proximal inner shaft 138 a of inner shaft assembly138 rotatably disposed within stiffener tube 134.

Inner shaft assembly 138 includes a relatively rigid proximal innershaft 138 a, a relatively rigid distal inner shaft 138 b, and anintermediate flexible drive cable 138 c interconnecting proximal innershaft 138 a and distal inner shaft 138 b. Desirably, intermediateflexible drive cable 138 c is non-rotatably connected to each ofproximal inner shaft 138 a and distal inner shaft 138 b, and slidablycoupled to at least one of proximal inner shaft 138 a and distal innershaft 138 b to accommodate and/or account for variations in length ofintermediate flexible drive cable 138 c when intermediate flexible drivecable 138 c is in a flexed condition. It is also desirable that thedrive cable 138 c is long enough that it extends proximally past themost proximal pivot of the articulation link. This reduces bendingstresses on the interface between the drive cable 138 c and the proximalinner shaft 138 a.

Proximal inner shaft 138 a extends into handle housing 112 and is actedupon by drive mechanism 116. A distal end portion of distal inner shaft138 b is slotted, defining a pair of tines 142 a and a central channel142 b. The distal end portion of distal inner shaft 138 b is configuredto retain a plurality of anchors 10 within distal tube portion 130 b ofanchor retaining/advancing assembly 130.

In particular, anchors 10 are loaded into the distal end portion ofdistal inner shaft 138 b of anchor retaining/advancing assembly 130 suchthat a pair of opposing threaded sections (not shown) of each anchor 10extend radially beyond a diameter of distal inner shaft 138 b and areslidably disposed within a helical groove of a coil 136 (FIG. 7) definedor provided in distal tube portion 130 b of anchor retaining/advancingassembly 130, and the pair of tines 142 a of the distal end portion ofdistal inner shaft 138 b are disposed within a pair of slotted sections(not shown) of each anchor 10.

As seen in FIGS. 3 and 7, a spiral or coil 136 is fixedly disposedwithin distal tube portion 130 b of anchor retaining/advancing assembly130. Distal inner shaft 138 b extends into and is rotatable within coil136.

As seen in FIGS. 1-3, 5 and 6, articulation joint 150 includes anarticulation link 152 having a proximal end 152 a and a distal end 152b. Proximal end 152 a of articulation link 152 is pivotally connected toa distal end of stiffener tube 134. Distal end 152 b of articulationlink 150 is pivotally connected to distal tube portion 130 b of anchorretaining/advancing assembly 130, at a location offset a transversedistance from a central longitudinal axis “X” of proximal tube portion130 a of anchor retaining/advancing assembly 130.

In accordance with the present disclosure, an articulation actuationbutton 118 may be slidably supported on handle housing 112. In use, itis contemplated that articulation actuation button 118 has a distal-mostportion wherein distal tube portion 130 b of anchor retaining/advancingassembly 130 is oriented at about 0° relative to the centrallongitudinal axis “X”, and a proximal-most portion wherein distal tubeportion 130 b of anchor retaining/advancing assembly 130 is oriented atabout 90° relative to the central longitudinal axis “X”.

Specifically, with articulation actuation button 118 in a distal-mostportion, and with distal tube portion 130 b of anchorretaining/advancing assembly 130 oriented at about 0° relative to thecentral longitudinal axis “X”, as articulation actuation button 118 ismoved in a proximal direction, articulation actuation button 118 drawsstiffener tube 134 is a proximal direction which draws articulation link152 in a proximal direction, causing distal tube portion 130 b of anchorretaining/advancing assembly 130 to pivot about pivot pin 130 c.

Additionally, with articulation actuation button 118 in anon-distal-most portion, and with distal tube portion 130 b of anchorretaining/advancing assembly 130 oriented at a non-0° relative to thecentral longitudinal axis “X”, as articulation actuation button 118 ismoved in a distal direction, articulation actuation button 118 pushesstiffener tube 134 is a distal direction which pushes articulation link152 in a distal direction, causing distal tube portion 130 b of anchorretaining/advancing assembly 130 to pivot about pivot pin 130 c towardan orientation of 0° relative to the central longitudinal axis “X”.

In use, when distal tube portion 130 b of anchor retaining/advancingassembly 130 is actuated to an off-axis orientation, as will bediscussed in greater detail below, distal tube portion 130 b of anchorretaining/advancing assembly 130 may be angled from between about 0° toabout 90° relative to the central longitudinal axis “X”.

In accordance with the present disclosure, distal tube portion 130 b ofanchor retaining/advancing assembly 130 is pivotable in a singledirection relative to proximal tube portion 130 a of anchorretaining/advancing assembly 130.

In an alternate embodiment, it is contemplated that handle assembly 110of tack applier 100 may rotatably support an articulation collar near aproximal end of anchor retaining/advancing assembly 130. It isenvisioned that the articulation collar may threadably engage with athreaded end or portion of stiffener tube 134 or some other articulationrod that is pivotably connected to articulation link 152. In thismanner, as the articulation collar is rotated, the threads of thearticulation collar act on the threads of stiffener tube 134 and causethe stiffener tube 134 to axially translate. As stiffener tube 134axially translates, said axial translation is transmitted toarticulation link 154 to effectuate articulation of distal tube portion130 b relative to proximal tube portion 130 a, as described above.

In accordance with the present disclosure, as seen in FIGS. 5 and 6,intermediate flexible drive cable 138 c extends from proximal tubeportion 130 a to distal tube portion 130 b of anchor retaining/advancingassembly 130, across articulation joint 150. Intermediate flexible drivecable 138 c is fabricated from a torsionally stiff and flexiblematerial, such as, for example, stainless steel. Flexible drive cable138 c is more flexible as compared to proximal inner shaft 138 a anddistal inner shaft 138 b.

Intermediate flexible drive cable 138 c defines a central longitudinalaxis “X1” which is off-set a radial distance “r” from the centrallongitudinal axis “X” of proximal tube portion 130 a of anchorretaining/advancing assembly 130. The central longitudinal axis “X1” ofintermediate flexible drive cable 138 c is off-set from the centrallongitudinal axis “X” of proximal tube portion 130 a of anchorretaining/advancing assembly 130 in a direction away from a direction ofarticulation of articulation joint 150, or in a direction away fromarticulation link 152.

As such, as seen in FIG. 6, when distal tube portion 130 b of anchorretaining/advancing assembly 130 is in an angled orientation, a radiusof curvature “R1” of intermediate flexible drive cable 138 c isrelatively greater than a radius of curvature “R2” of a comparableflexible drive cable that would be located along the centrallongitudinal axis “X” of proximal tube portion 130 a of anchorretaining/advancing assembly 130.

In this manner, by providing for a larger radius of curvature “R1” forintermediate flexible drive cable 138 c, it is contemplated, inaccordance with the present disclosure, that an intermediate flexibledrive cable 138 c having a relatively larger diameter or constructedfrom a relatively stiffer material can be used, as compared to anycomparable flexible drive cable that would be located along the centrallongitudinal axis “X” of proximal tube portion 130 a of anchorretaining/advancing assembly 130.

In so doing, relatively greater torsional forces, and more accuraterotation, can be transmitted along intermediate flexible drive cable 138c as compared to any comparable flexible drive cable that would belocated along the central longitudinal axis “X” of proximal tube portion130 a of anchor retaining/advancing assembly 130.

Intermediate flexible drive cable 138 c may have an outer diameter ofabout 0.08″. Proximal tube portion 130 a and distal tube portion 130 beach have an outer diameter of about 0.22″. A ratio of the outerdiameter of the intermediate flexible drive cable 138 c to the outerdiameter of either proximal tube portion 130 a or distal tube portion130 b is about 2.8.

In accordance with the present disclosure, as seen in FIG. 8, it iscontemplated that tack applier 100 may be configured such that distaltube portion 130 b of anchor retaining/advancing assembly 130 isconfigured and adapted to releasably and selectively receive adisposable loading unit (DLU) or single use loading unit (SULU), whereinthe DLU or SULU includes at least an outer tube, a coil or helicalthread provided along an interior of the outer tube, and an inner shaftrotatably disposed within the coil or helical thread. The inner shaftincluding a splined distal end portion configured to support at leastone anchor 10, and a proximal end portion configured and adapted formechanical and non-rotational connection to a distal end of an exemplaryintermediate flexible drive cable 138 c.

Turning now to FIGS. 9 and 10, an articulation joint 250, in accordancewith the principles of the present disclosure, may be incorporated intoan endoscopic surgical device in the form of an endoscopic surgicalstapler 200. Endoscopic surgical stapler 200 may be in the form of anelectromechanical, hand-held, powered surgical system including anelectromechanical, hand-held, powered surgical instrument that isconfigured for selective attachment thereto of a plurality of differentend effectors (including a surgical stapler), via a shaft assembly, thatare each configured for actuation and manipulation by theelectromechanical, hand-held, powered surgical instrument. Reference maybe made to International Application No. PCT/US2008/077249, filed Sep.22, 2008 (Inter. Pub. No. WO 2009/039506) and U.S. patent applicationSer. No. 12/622,827, filed on Nov. 20, 2009, the entire content of eachof which being incorporated herein by reference, for a detaileddescription of the construction and operation of an exemplaryelectromechanical, hand-held, powered surgical instrument.

Endoscopic surgical stapler 200 includes an endoscopic shaft assembly210 having an articulation joint 250, and a flexible drive cable 238 c,extending through articulation joint 250, to effectuate a closure and afiring of an end effector 300.

Flexible drive cable 238 c is fabricated from a torsionally stiff andflexible material, such as, for example, stainless steel. Flexible drivecable 238 c defines a central longitudinal axis “X1” off-set a radialdistance “r” from a central longitudinal axis “X” of shaft assembly 210.Flexible drive cable 238 c includes a proximal end that is coupled to adistal end of rotatable drive shaft 212. Flexible drive cable 238 cincludes a distal end that is coupled to a rotation nut, whereinrotation of flexible drive cable 238 c results in corresponding rotationof the rotation nut.

The central longitudinal axis “X1” of intermediate flexible drive cable138 c is off-set from the central longitudinal axis “X” of proximal tubeportion 130 a of anchor retaining/advancing assembly 130 in a directionaway from a direction of articulation of articulation joint 150, or in adirection away from articulation link 152.

Articulation joint 250 includes an articulation link 240 having aproximal end 240 a and a distal end 240 b. Proximal end 240 a ofarticulation link 240 is pivotally connected to a distal end of anarticulation bar 278. A distal end 240 b of articulation link 240 ispivotally connected to a distal neck housing 236 of an endoscopic shaftassembly 210, at a location offset a radial distance from thelongitudinal axis “X” of shaft assembly 210.

Distal neck housing 236 is configured and adapted for selectiveconnection with an end effector 300.

Shaft assembly 210 may include a reinforcing coil spring 244 surroundingflexible drive cable 238 c. Reinforcing coil spring 244 functions tohelp keep flexible drive cable 238 c from kinking during articulation ofend effector 300. Reinforcing coil spring 244 also functions to helpkeep flexible drive cable 238 c from failing due to unwinding and/or“pig tailing” during rotation thereof.

In operation, as flexible drive cable 238 c is rotated, due to arotation of first rotatable proximal drive shaft 212, said rotation istransmitted, through flexible drive cable 238 c, to the distal end offlexible drive cable 238 c and on to the rotation nut. With end effector300 coupled to distal neck housing 236 of shaft assembly 210, andspecifically, with a drive screw of end effector 300 coupled thereto viaa drive axle 326, said rotation results in actuation of end effector300.

Also in operation, upon an axial translation of articulation bar 278,for example in a proximal direction, articulation bar 278 acts onarticulation link 240 to cause articulation link 240 to translate in aproximal direction. As articulation link 240 is axially translated in aproximal direction, articulation link 240 acts on distal neck housing236 to cause distal neck housing 236 to pivot about a pivot axis ofpivot pin 234. As distal neck housing 236 is pivoted, distal neckhousing 236 acts on end effector 300 to articulate end effector 300relative to the longitudinal axis “X” of shaft assembly 210.

As such, as seen in FIG. 10, when end effector 300 is in an angledorientation, a radius of curvature “R1” of flexible drive cable 238 c isrelatively greater than a radius of curvature “R2” of a comparableflexible drive cable that would be located along the centrallongitudinal axis “X” of shaft assembly 210.

In this manner, by providing for a larger radius of curvature “R1” forflexible drive cable 238 c, it is contemplated, in accordance with thepresent disclosure, that a flexible drive cable 238 c having arelatively larger diameter or constructed from a relatively stiffermaterial can be used, as compared to any comparable flexible drive cablethat would be located along the central longitudinal axis “X” of shaftassembly 210.

In so doing, relatively greater torsional forces, and more accuraterotation, can be transmitted along flexible drive cable 238 c ascompared to any comparable flexible drive cable that would be locatedalong the central longitudinal axis “X” of shaft assembly 210.

Flexible drive cable 238 c may have an outer diameter of about 0.08″.

Shaft assembly 210 has an outer diameter of about 0.22″. A ratio of theouter diameter of the flexible drive cable 238 c to the outer diameterof shaft assembly 210 about 2.8.

Reference may be made to U.S. patent application Ser. No. 13/799,379,filed on Mar. 13, 2013, entitled “Apparatus for Endoscopic Procedures”,the entire content of which is incorporated herein by reference, for adetailed discussion of the construction and operation of shaft assembly210 and end effector 300.

Reference may be made to U.S. patent application Ser. No. 13/280,898,filed on Oct. 25, 2011, entitled “Apparatus for Endoscopic Procedures”,the entire content of which is incorporated herein by reference, for adetailed discussion of the construction and operation of end effector300. End effector 300 may be configured and adapted to apply a pluralityof linear rows of fasteners, which in embodiments may be of varioussizes, and which, in certain embodiments may have various lengths orrows, e.g., about 30, 45 and 60 mm in length.

In accordance with the present disclosure, it is contemplated thathandle assembly 100 may be replaced by an electromechanical controlmodule configured and adapted to drive the flexible drive cables to fireor actuate the surgical device. The electromechanical control module mayinclude at least one microprocessor, at least one drive motorcontrollable by the at least one microprocessor, and a source of powerfor energizing the at least one microprocessor and the at least onedrive motor.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the length of the linear rowof staples or fasteners may be modified to meet the requirements of aparticular surgical procedure. Thus, the length of the linear row ofstaples and/or fasteners within a staple cartridge assembly may bevaried accordingly. Therefore, the above description should not beconstrued as limiting, but merely as exemplifications of preferredembodiments. Those skilled in the art will envision other modificationswithin the scope and spirit of the claims appended thereto.

What is claimed is:
 1. An endoscopic surgical device, comprising; ahandle assembly including a handle housing and a trigger operativelyconnected to the handle housing, and a drive mechanism actuatable by thetrigger; an endoscopic anchor retaining/advancing assembly extendingfrom the handle assembly, the endoscopic anchor retaining/advancingassembly including: a proximal tube portion and a distal tube portionpivotably connected to one another at an articulation joint, each of theproximal tube portion and the distal tube portion defining a centrallongitudinal axis; a proximal inner shaft rotatably disposed within theproximal tube portion, wherein the proximal inner shaft is relativelyrigid, and wherein the proximal inner shaft is mechanically connected tothe drive mechanism such that actuation of the trigger results inrotation of the proximal inner shaft; a distal inner shaft rotatablydisposed within the distal tube portion, wherein the distal inner shaftis relatively rigid; and an intermediate drive cable mechanicallyinterconnecting the proximal inner shaft and the distal inner shaft,wherein the intermediate drive cable is relatively flexible as comparedto the proximal inner shaft and the distal inner shaft, wherein theintermediate drive cable extends from and between the proximal tubeportion and the distal tube portion, across the articulation joint,wherein the intermediate drive cable defines a central longitudinal axisand wherein the central longitudinal axis of the intermediate drivecable is off-set a radial distance from the central longitudinal axis ofthe proximal tube portion and the distal tube portion; and at least onefastener loaded in the distal tube portion, wherein the at least onefastener is acted upon by the distal inner shaft upon an actuation ofthe trigger.
 2. The endoscopic surgical device according to claim 1,wherein the distal tube portion is articulatable between anon-articulated orientation and a plurality of articulated orientationsrelative to the proximal tube portion.
 3. The endoscopic surgical deviceaccording to claim 2, wherein the central longitudinal axis of theproximal tube portion and the central longitudinal axis of the distaltube portion define a central radius of curvature for each articulatedorientation of the distal tube portion relative to the proximal tubeportion, and wherein the central longitudinal axis of the intermediatedrive cable defines a radius of curvature that is greater than thecentral radius of curvature for each articulated orientation of thedistal tube portion relative to the proximal tube portion.
 4. Theendoscopic surgical device according to claim 2, wherein the centrallongitudinal axis of the intermediate drive cable is off-set from thecentral longitudinal axis of the proximal tube portion and the centrallongitudinal axis of the distal tube portion in a direction away from adirection of articulation of the distal tube portion relative to theproximal tube portion.
 5. The endoscopic surgical device according toclaim 1, wherein the intermediate drive cable has an outer diameter ofabout 0.08″.
 6. The endoscopic surgical device according to claim 1,wherein the intermediate drive cable has an outer diameter of about0.08″; and wherein the proximal tube portion and the distal tube portioneach have an outer diameter of about 0.22″.
 7. The endoscopic surgicaldevice according to claim 1, wherein a ratio of an outer diameter of theintermediate flexible drive cable to an outer diameter of either theproximal tube portion or the distal tube portion is about 2.8.
 8. Anendoscopic surgical device, comprising: an endoscopic anchorretaining/advancing assembly including: a proximal tube portion and adistal tube portion pivotably connected to one another at anarticulation joint, each of the proximal tube portion and the distaltube portion defining a central longitudinal axis; a proximal innershaft rotatably disposed within the proximal tube portion, wherein theproximal inner shaft is relatively rigid, and wherein the proximal innershaft is mechanically connected to a drive mechanism such that actuationof the drive mechanism results in rotation of the proximal inner shaft;a distal inner shaft rotatably disposed within the distal tube portion,wherein the distal inner shaft is relatively rigid; and an intermediatedrive cable mechanically interconnecting the proximal inner shaft andthe distal inner shaft, wherein the intermediate drive cable isrelatively flexible as compared to the proximal inner shaft and thedistal inner shaft, wherein the intermediate drive cable extends fromand between the proximal tube portion and the distal tube portion,across the articulation joint, wherein the intermediate drive cabledefines a central longitudinal axis and wherein the central longitudinalaxis of the intermediate drive cable is off-set a radial distance fromthe central longitudinal axis of the proximal tube portion and thedistal tube portion
 9. The endoscopic surgical device according to claim8, wherein the distal tube portion is articulatable between anon-articulated orientation and a plurality of articulated orientationsrelative to the proximal tube portion.
 10. The endoscopic surgicaldevice according to claim 9, wherein the central longitudinal axis ofthe proximal tube portion and the central longitudinal axis of thedistal tube portion define a central radius of curvature for eacharticulated orientation of the distal tube portion relative to theproximal tube portion, and wherein the central longitudinal axis of theintermediate drive cable defines a radius of curvature that is greaterthan the central radius of curvature for each articulated orientation ofthe distal tube portion relative to the proximal tube portion.
 11. Theendoscopic surgical device according to claim 9, wherein the centrallongitudinal axis of the intermediate drive cable is off-set from thecentral longitudinal axis of the proximal tube portion and the centrallongitudinal axis of the distal tube portion in a direction away from adirection of articulation of the distal tube portion relative to theproximal tube portion.
 12. The endoscopic surgical device according toclaim 8, wherein the intermediate drive cable has an outer diameter ofabout 0.08″.
 13. The endoscopic surgical device according to claim 8,wherein the intermediate drive cable has an outer diameter of about0.08″; and wherein the proximal tube portion and the distal tube portioneach have an outer diameter of about 0.22″.
 14. The endoscopic surgicaldevice according to claim 8, wherein a ratio of an outer diameter of theintermediate flexible drive cable to an outer diameter of either theproximal tube portion or the distal tube portion is about 2.8.
 15. Theendoscopic surgical device according to claim 8, further comprising atleast one fastener loaded in the distal tube portion, wherein the atleast one fastener is acted upon by the distal inner shaft upon anactuation of the drive mechanism.